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Ultrashort regimen of lansoprazole-amoxicillin-azithromycin for eradicating Helicobacter pylori
C Chahine1, O Moukhachen, M Chedid
1School of Pharmacy, Lebanese American University, Byblos, Lebanon.
Abstract:
The efficacy and safety of two ultrashort azithromycin-containing regimens for Helicobacter pylori infection were studied. Patients positive for H. pylori infection were assigned to receive either a three-day drug regimen (group A) or a five-day regimen (group B). In both groups, patients received lansoprazole 30 mg p.o. twice daily on day 1 and, on days 2 and 3, lansoprazole 30 mg p.o. twice daily, amoxicillin 1 g (of anhydrous amoxicillin) p.o. twice daily, and azithromycin 500 mg (of anhydrous azithromycin) p.o. twice daily. Group B patients received lansoprazole 30 mg p.o. twice daily and amoxicillin 1 g p.o. twice daily for two additional days. Gastric biopsy specimens were subjected to culture and susceptibility testing. A minimum of four weeks after the completion of therapy, the patients underwent a 14C-urea breath test to determine whether H. pylori had been eradicated. A total of 28 patients were enrolled (15 in group A and 13 in group B). Treatment was well tolerated. H. pylori was eradicated in 4 (36%) of 11 patients in group A and 2 (22%) of 9 group B patients (26.6% and 15.4%, respectively, in intention-to-treat analysis). None of the isolates of H. pylori showed resistance to amoxicillin or clarithromycin. Regimens consisting of lansoprazole plus two or four days of azithromycin and amoxicillin therapy eradicated H. pylori in 36% and 22% of patients, respectively.
Insights
Two short azithromycin regimens for Helicobacter pylori infection showed modest eradication rates. A 3-day regimen achieved 36% eradication, while a 5-day regimen achieved 22%. Further research is needed for optimal H. pylori treatment.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Pharmacology
Background:
- Helicobacter pylori infection is a significant global health concern.
- Developing effective and safe eradication regimens is crucial for managing H. pylori-related diseases.
- Ultrashort antibiotic regimens are being explored to improve treatment compliance and reduce resistance.
Purpose of the Study:
- To evaluate the efficacy and safety of two distinct ultrashort azithromycin-containing regimens for H. pylori eradication.
- To compare a 3-day regimen with a 5-day regimen in terms of H. pylori eradication rates.
- To assess the tolerability of these novel treatment strategies.
Main Methods:
- A randomized study involving 28 patients with H. pylori infection.
- Group A received a 3-day regimen: lansoprazole, azithromycin, and amoxicillin.
- Group B received a 5-day regimen: lansoprazole, azithromycin, and amoxicillin, with extended amoxicillin and lansoprazole.
- H. pylori eradication was confirmed using a 14C-urea breath test.
Main Results:
- H. pylori eradication was achieved in 36% of patients in the 3-day group (Group A) and 22% in the 5-day group (Group B).
- Intention-to-treat analysis showed eradication rates of 26.6% and 15.4% for Group A and B, respectively.
- Both regimens were well tolerated by the study participants.
- No H. pylori isolates exhibited resistance to amoxicillin or clarithromycin.
Conclusions:
- Ultrashort azithromycin-based regimens demonstrate limited efficacy for H. pylori eradication.
- The 3-day regimen showed a higher, though still modest, eradication rate compared to the 5-day regimen.
- Further investigation into optimizing the duration and combination of antibiotics is warranted for effective H. pylori treatment.